Fuaireamar amach inné gur seoladh litreacha chuig 2,260 teaghlach faoin scannal tubaisteach maidir le hobráidí chromán na leanaí. Tá tuismitheoirí fós feargach nach bhfuil an t-eolas ón Rialtas ná na hospidéil á thabhairt dóibh. Yesterday we learned the scope and scale of the devastating hip surgery scandal. Some 2,260 families have been sent letters. I raised this issue on Leaders' Questions two months ago in March. I called on the Government to get ahead of it and to tell parents what was going on. Parents are still being kept in the dark, even today. What does it say about the Government that facing into this scandal, it took two months to even ask Children's Health Ireland, CHI, how many children were affected and how many letters have been issued. The Taoiseach this week was still trying to downplay these letters, suggesting they were issued to reassure parents on the back of a media leak of the draft report. That is nonsense. These letters were sent out to implement an early recommendation of the draft audit. The recommendation calls for the recall of all these children for follow-up.

Why is CHI implementing an early recommendation of the draft audit? It is because the draft audit is shocking, devastating and damning. It states that 60% of surgeries in one hospital and 80% of surgeries in another were unnecessary. Let what that means sink in for a moment.

Children as young as one years of age have had their hips opened up, cutting into their bones. They have had to learn how to walk again. They have been left with scars for their life, and now we find out that these surgeries may have been unnecessary. Imagine having to bring your two-year-old little girl into that operating theatre, having to leave her in the hands of the system, only to find out that the surgery, the pain, the learning how to walk again and that scar she has on her hip was never necessary and the surgery did not need to happen. That is the experience of so many parents out there. It is the experience of one mother who I spoke to this morning. In 2015 she brought her little girl, two years of age, for surgery on her right hip. It was the only hip that was ever mentioned in all the assessments. After the operation she was told that she needed surgery on the other hip as well. She described feeling like a rabbit in headlights, but like any parent would, she followed the medical advice and after five weeks her daughter had the second operation. When this letter dropped in her letter box seven weeks ago, she was immediately concerned. She sent 30 emails over a period of five weeks to CHI without one response. Only when she got her solicitor involved did she get a response. She sought a second medical opinion. She is now sure that the first hip operation, at best, was premature and the second operation was not needed at all. She is frustrated at the lack of answers from CHI and from the Government. This is not an isolated case.

Every family I have spoken to over the past two months are looking for one thing more than anything else. They want to know if the surgery that was carried out on their child was necessary or not. The audit is not going to give them that answer. It is an anonymised study. It will not give them the individual answer. The Government is asking parents to wait. It is asking them to trust the process but trust has completely broken down. I have a simple question for the Government today on behalf of parents who have contacted me, Deputies Cullinane and Carthy and many others in our party and across the benches. Can you tell me that for every single one of those 2,260 anxious families, every one of their children will have access to an independent clinical assessment that will answer the simple question for them as to whether their child was operated on necessarily or unnecessarily? When will they be given access to that clinical assessment?

I asked the Government two months ago to get ahead of this. It is not fair that it has left families in this situation for that period.

I thank the Deputy for raising this matter. We agree on a number of things here. We are all working on behalf of the children the Deputy has mentioned. We are all working to make sure we get answers to what has happened here. We have discussed this a number of times in the Chamber. We are all extremely concerned at the thought of a child having a surgery where that was not necessary. We can probably all point to somebody we know or who has come to us where they were recommended the surgery and did not go through with it or were recommended it and went through with it but it was not needed, or indeed where they needed the surgery. The issue we need to get to the bottom of is where surgeries were carried out on children where they were not needed and where injury was inflicted on young people in circumstances where surgery simply was not needed. The most important thing we need to ascertain at the outset is the facts. That is why this review is taking place. I appreciate that we all want to know the facts as quickly as possible but we do not have those yet. I know the Deputy is referring to parts of the report but it has not been published. The Minister has not seen the report. While it has been made very clear to her that she will have the report in the coming weeks, we do not yet have the absolute facts of the review that is taking place. We all have a responsibility in this Chamber to make sure that what we are talking about is based on facts and reports that are published.

It is also important to assure families where surgeries are taking place at the moment. We know there are children who do need surgery today. Revised procedures have been put in place and new protocols are in place. All surgeries are being assessed by a multidisciplinary team before any decision is being taken. Separate work is also being done which will follow through from the review to make sure absolute best and up-to-date practice, which is in place in other countries and should be in place here, is adhered to if any child is being put forward for these potential surgeries.

In terms of the overall numbers, we have to be careful. The figure of just over 2,200 young people does not suggest every single one of those young people had surgeries where they should not have had them. We have to be clear about that. It is important that these families have been written to and engaged with by CHI, but also by Cappagh. We know that 1,700 of these were with CHI and 500 of them were with Cappagh. Where there has not been follow-up in these instances, it is important that now begins. Many families where surgeries have taken place have had follow-ups, engagement and consultation with their consultants and their teams. For those who have not, there is a clear commitment that engagement and consultation will happen immediately.

As the Deputy said at the outset, of most importance is that we ascertain the facts. What has happened? What practices were followed? How many children were impacted? What do we need to do now? Above all and to the Deputy's point, how do we ensure that any follow-on support, including medical support, and any assistance that is needed by those families and children is provided immediately? However, we have to get to the bottom of this. We will have those facts, but we do not have them yet. We do not have the report. We know that the initial recommendation, as published by CHI in its statement this week, is the reason it sent the letters to families, ensuring that engagement starts immediately and we are not just waiting on the report. We need to have those facts and that information so that whatever practice is followed moving forward ensures this situation does not happen again and, above all, we can stand by the medical advice we are given when our children go into hospital and know that best practice is being applied in every case.

With respect, that is not good enough. The fact is that 2,260 letters were issued. The fact is the letters were issued as part of the implementation of a recommendation of the draft audit. The fact is the draft audit said all of those children should be recalled. The fact is there are 2,260 families out there that are anxious. The fact is none of those families knows whether their child needed to be operated on or not. The fact is the Government has no plan at this point in time to provide a pathway that will allow them to determine if that is the case. The audit is not going to tell them that.

I asked the Government two months ago to get ahead of this. I pleaded with the Government. We have given countless examples of families who are no longer waiting for the Government and are instead seeking a second opinion. They have gone to America. They are going to London. They are putting their hands in their own pockets because the Government is giving them no answers. The fact is the parent I talked to this morning sent 30 letters looking for information without a response.

Hear, hear.

The Government needs to deal with this. I know every single person in this Chamber would be appalled at the idea of a young girl being opened up, her bone being chiselled into unnecessarily and left with a scar and pain, but it is the Government's responsibility to provide a pathway and certainty for those families. I ask the Minister a simple question - will the Government ensure that every single one of the 2,260 families that got that letter will be given an independent clinical pathway to determine whether their child was operated on unnecessarily? That is the first question they want answered.

Hear, hear.

I cannot be any clearer with the Deputy on this. We first need to ascertain the facts. We need to ensure that we have absolute clarity as to what has happened, how many people are involved and how we make sure this never happens again. At the same time, we need to ensure that, where families need follow-on care and further information and clinical support, that is provided. The Minister for Health could not be any clearer in the commentary she has made over the past number of months. We will provide any support that families and children need, going as far back as 2010. That year was chosen because 15 years is the skeletal reference age at which a child's bone density matures. Those are the parameters that have been chosen. Any child and his or her family within that timeframe will be provided with support. That is why those letters were written initially. Many of those families will have had continued engagement. Many of those families where surgeries happened years ago will have been engaging with their teams and will have had that support. However, for those who have not - I accept there are those who might not have and who do not know whether the operations should have happened or not - we need to ensure that we find that information as quickly as possible. Without a shadow of a doubt, they will get the assistance and medical support they need if this has not been done correctly.

The Government has repeatedly stated that it does not want to see a drip feed of information about the audit of hip surgeries at the three children's hospitals but that is what we are getting. Any information about the scandal has had to be dragged out of the Government. Yesterday, responding to me, the Taoiseach confirmed for the first time that he expected the audit to be finalised next week. Why did it take so long to provide this basic information, which families have been spending months trying to get? It also took until yesterday to reveal that more than 2,200 families have now received letters as result of the audit. On Tuesday, the Taoiseach did not even know the correct reason those letters had been sent.

Unnecessary and painful surgery on young children is horrific. The impacts of these surgeries can be hugely traumatic. Families are devastated to find out this has happened to their children. Parents who have contacted me do not know where to go to get their questions answered. At the very least, the Government must address this now. The lack of basic information, the level of inaccurate information and the drip feed of information coming from the Government is not acceptable. Why is the Government keeping families in the dark until the final audit is published?

On foot of the draft audit, a number of measures have already been taken. More than 2,200 letters have been sent out to families, a multidisciplinary team of clinicians is already reviewing cases and an action plan has been put in place. A lot of things are happening in the background but what we are not getting is upfront or complete information about it. This is causing considerable distress for families who are desperate for information. The entire process has been dealt with shambolically by the Government. Families have been left in the dark and this needs to end now.

The Taoiseach told me yesterday that he expected the audit to be finalised by the end of next week. Does this mean parents will have it in their hands next week? What day will they receive it? Can the Minister outline the full list of recommendations that have already been put into place at Children's Health Ireland and Cappagh as a result of the audit? Will the Minister for Health answer questions next week in the Dáil when the audit is finalised? Will the Minister for education give me a commitment on that?

I do not think it is helpful for any of us to be discussing certain elements without having the full facts. I appreciate fully and agree with the Deputy that families want all of the facts. They want the information and they do not want it piecemeal. They certainly do not want parts of an unpublished document being published elsewhere and not coming through the Minister or not having that direct engagement with the Minister, CHI or the other hospitals involved.

The most important thing is to have the review completed. The information that has been provided to me is that the Minister for Health has been told she will have the review next week. I do not have the exact day, but as soon as the Minister has it next week and is able to, she will engage with the families first and foremost. She has recently spent quite a number of hours in the Dáil answering questions, not just on this, but on many other issues as well. There has never been any doubt that the Minister does not want to engage, does not want to talk to families or does not want to discuss this matter in the Chamber.

To go back to the basic facts here as we have all outlined, there is not a single one of us who could even comprehend what it is like for a family to believe or know that their child has had a surgery the child did not need. As a mother of two young children, the very thought of that is terrifying. I apply that to anybody who has children, grandchildren, nieces or nephews. We all want to make sure that we get to the bottom of this, that those who need any further clinical assistance get it and, above all, that the practices that have to change do. That is what is happening already. While we need to ascertain the facts for the families involved, it does not prevent us from starting work on looking at why these practices were carried out and how to ensure that surgeries happening at the moment are not applying the same practices. That change is taking place already. For any surgeries at the moment, there is a multidisciplinary team that sits down, looks at the cases and then decides whether to go forward. That is really important progress that has been made.

In terms of the letters, it is important that families have communication throughout all of this. There is piecemeal information being put out there and, in my understanding, it was the Minister who asked for the correct figure to be put out there, as it was increasing and decreasing. We now have that figure because it was asked to be put into the public domain. That alleviated some of the concerns around the increasing numbers overall. We have established helplines or email addresses for patients to make queries: there is ceo@childrenshealthireland.ie and cappaghkidsenquiries@nohc.ie. These are dedicated email addresses that have been put in place for families to be able to communicate separate to the letters they have received, which very clearly state that if they have not had engagement from their hospitals, follow-up or engagement in the past year or 15 years, we will engage with them and reach out to them.

There are a number of strands. I appreciate that it would be better if everything was happening at once. The review is looking at exactly what has happened. Separately, CHI has given an element of information to be able to engage with those families and to make that communication at the very outset, which is set out as best practice. Third, work is under way in our hospitals to make sure that the same practice is not being applied in respect of anything that is happening now or any procedures that are in place. Of course, once this report is received, the first thing the Minister will do is reach out to the families and make sure that she can engage with them on the facts and information that she has.

For parents and their families not to have information that they are seeking is hugely distressing for them. It is the least they deserve and expect. We know at this stage, from some of the information that has been drip-fed, that some of the recommendations in the draft audit are being implemented. Why can the Government not share with us all of the recommendations in that draft audit? It is already working on implementing a number of them, which parents have found out, so why not share all of them with us? Why withhold that at this stage? The Government is working away on implementing recommendations, yet it will not share with us and the families what those recommendations are. Will the Minister now share those recommendations, which the Government is working on, with the families and the public?

I cannot be any clearer on this. The Minister does not have the report. She does not have recommendations. While elements have been unhelpfully published in online articles, the report has not been presented to the Minister. It stands to reason that while this work is being done, the hospital is not going to sit still and say it will wait for everything. It knows it needs to change its practices. That is why it has put new multidisciplinary teams in place. It knows it is important to write out and to engage with the families as it has identified them because those figures have been intentionally put into the public domain to try to alleviate any concerns that they are escalating beyond anything we would have thought. That work is under way.

It is simply not the case that the Minister has and is working on a concrete set of recommendations and is not telling anybody. The report has not been finalised and presented to her, but once it has been, the Minister will first and foremost engage with families, Cappagh hospital, CHI and of course will engage with the Dáil to see what we need to do now and what the next steps are. Where there are recommendations and changes that need to be made in procedures and patient and client engagement in our hospitals, they can proceed and start immediately.